Borderline Personality Disorder Treatment, Recovery, and Remission

If you or someone you love has been diagnosed with borderline personality disorder (BPD), your first question will likely be whether the condition can be cured. While there is no definitive cure for BPD, it is absolutely treatable. In fact, with the right treatment approach, you can be well on the road to recovery and remission.

While remission and recovery are not necessarily a "cure," both constitute the successful treatment of BPD. By definition:

• Remission is the stage where you no longer meet the specified criteria for a BPD diagnosis.
• Recovery is less well-defined, but suggests that you are able to function in all aspects of your life for an extended period of time. This includes holding down a job and maintaining meaningful relationships.

Treatment Goals

In the past, many doctors believed that BPD was untreatable and lumped it together with other hard-to-treat conditions like antisocial personality disorder (ASPD). As scientists have gained greater insights about the disorder, newer treatment approaches have helped many achieve lasting remission from BPD, in some cases without the use of drugs.

Results can differ, with some responding better than others. But for the most part, with informed and individualized treatment, BPD can be controlled in the same way as diabetes or other chronic conditions. The disease may not go away, but it can be managed in a way that affords a better quality of life.

Remission Rates

A 2015 study reported that most people with BPD will no longer meet the diagnostic criteria for the condition by the time they reach adulthood. By all accounts, most people tend to eventually outgrow their symptoms and achieve remission as part of the natural course of the disease.

A study published in 2012 followed 290 patients with BPD every two years for 16 years. What they found was that remission (defined as no longer meeting the diagnostic criteria for at least two years) tended to occur spontaneously within two to eight years of the diagnosis and initial treatment.

After 16 years, 99% had achieved a two-year remission, while 78% had experienced an eight-year remission. The same study revealed that symptom relapses tended to wane over time as well, from a high of 36% after two years to around 10% by eight years.

It is important to note, however, that these statistics are based on people who were diagnosed and treated for BPD. The results did not include what types of treatment were provided or what maintenance therapies may have been used. As such, it is not clear how much the various treatments influenced remission rates or if undiagnosed people will outgrow the condition as well.

Treatment Approaches

The treatment of BPD can vary based on the severity of symptoms and/or any co-occurring disorders. The tools for treatment typically include psychotherapy and medications.

Psychotherapy

The backbone treatment for BPD is psychotherapy, also known as talk therapy. Among the various approaches:

• Cognitive behavioral therapy (CBT) is the foundational structured approach to talk therapy incorporated into all other forms of psychotherapy.
• Dialectical behavior therapy (DBT) is a type of CBT that aims to identify and change negative thinking patterns, incorporating skills training to control emotions and tolerate distress.
• Mentalization-based therapy (MBT) aims to improve mentalization (the process by which we make sense of each other and ourselves, implicitly and explicitly).
• Schema-focused therapy (SFT) aims to identify and change deeply held thought and behavior patterns associated with our past (usually those we cling to for emotional survival).
• Transference-focused therapy (TFT) aims to prevent negative feelings about past experiences and people being transferred to current experiences and people.
• Systems training for emotional predictability and problem solving (STEPPS) is a 20-week educational program that helps people with BPD identify the behaviors and feelings associated with their diagnosis and gives them the skills necessary to change behaviors and manage feelings.

All of these therapies are appropriate for BPD treatment, approaching the disorder in slightly different ways. There is not one that is inherently better than the others. The choice depends largely on the effectiveness of your interactions with your therapist and your openness to the technique.

Never be afraid to ask why the therapist has chosen a specific therapeutic practice. It can help you better understand the aims of the treatment and decide whether it is the right approach for you.

Medications

Medications can be helpful in treating some of the symptoms of BPD. While drugs are not always needed, some of the more commonly prescribed include:

• Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) commonly used in first-line therapy
• Antipsychotics, such as Zyprexa (olanzapine) which is known to reduce impulsivity, hostility, and psychotic symptoms of BPD
• Mood stabilizers, including Topamax (topiramate), Lamictal (lamotrigine), and Depakote (valproate semisodium) which may be useful in treating BPD aggression
• Anti-anxiety medications, including Ativan (lorazepam), Klonopin (clonazepam), Xanax (alprazolam), and Valium (diazepam)

Co-Occurring Conditions

According to a report from the National Institute of Mental Health (NIMH), 85% of people with BPD will have at least one other mental health disorder, including anxiety disorders, impulse-control disorders, substance abuse or dependence disorders, and mood disorders (like major depressive disorder or MDD).

People with BPD will often meet the criteria for other personality disorders as well. The average number of co-occurring conditions in BPD is three. These co-occurring conditions (also known as comorbidities) can make treatment far more complex and result in delayed or missed diagnoses due to overlapping symptoms.

When a dual diagnosis is made, treatment is usually staged so that the symptom with the greatest likelihood of success is treated first. For instance, if you also have MDD, a common BPD comorbidity, you would be prescribed an antidepressant to reduce depression symptoms common to both MDD and BPD.

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Coping

If you think that you have BPD or have been diagnosed with the condition, there are steps you can take to better cope as you explore treatment options.

• Do not panic. Remember that your chances of remission are good. As with all mental health disorders, early diagnosis and treatment will almost invariably afford better results than a delayed diagnosis and treatment.
• Seek specialists experienced in BPD. This not only avoids missed diagnoses and comorbidities, but it also improves your chance of receiving the most up-to-date treatment, ideally with the fewest side effects and complications.

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• Find the right therapist for you. Therapy relies heavily on trust and open interaction. Take the time to interview several therapists, zeroing in on someone with whom you feel safe, comfortable, and supported.
• Educate yourself. Take the time to learn about your condition and become an advocate in your own care. You will feel more empowered by doing so and be better equipped to participate as a partner rather than a follower.
• Apply new skills. Your treatment should never be solely confined to medications or therapy sessions. There are plenty of self-help strategies you can incorporate into your life. These include journaling, expressive writing, art therapy, and mindfulness meditation.
• Involve your family. A BPD diagnosis affects the entire family. Treatment is often more successful if others participate as it helps repair emotional fractures that compound your illness. Family therapy can not only help you recover from BPD, but it can also help your family as well.